腹腔镜胰体尾切除术选择策略临床研究(附56例报告)  

Laparoscopic resection of pancreatic body and tail:A report of 56 cases

作　　者：洪德飞[1,2] 林志川 张宇华[1] 张成武[1] 孙晓东[1] 吴伟顶[1] 成剑[1] 卢毅[1] 

机构地区：[1]浙江省人民医院肝胆胰外科,浙江杭州310014 [2]上海吴盂超医学医疗中心,上海201805 [3]漳州市人民医院,福建漳州363000

出　　处：《中国实用外科杂志》2015年第12期1325-1328,共4页Chinese Journal of Practical Surgery

基　　金：浙江省科技厅重大专项(No.2013C03046);浙江省卫计委重点学科重点资助项目(No.2015ZDA004)

摘　　要：目的探讨腹腔镜胰体尾切除术治疗胰体尾占位性病变的术式选择策略和操作技巧。方法回顾性分析浙江省人民医院和漳州市人民医院2012年4月至2014年6月采用腹腔镜胰体尾切除术治疗的56例胰体尾占位性病变病人的临床资料。结果56例中中转开腹3例（5．4％），余53例（94．6％）均顺利完成手术。联合脾脏切除、保留脾血管保脾（Kimura法）和离断脾血管保脾（Warshaw法）的腹腔镜胰体尾切除术分别为3l例（58．5％）、19例（35．8％）和3例（5．7％）。手术时间70—230（170±35）min，出血量50—310（110±34）mL，术后住院时间5～35（9±6）d。术后并发A级胰瘘13例（23．2％），B级胰瘘1例（1．8％）、腹腔脓肿1例（1.8％）、肺炎2例（3．6％）。结合影像学和术后病理学检查报告分析，中转开腹、联合脾脏切除和Warshaw法：胰腺导管腺癌12例、肿瘤直径〉5cm的交界性胰腺肿瘤23例和慢性胰腺炎2例。Kimura法：均为肿瘤直径〈5cm的良性或交界性胰体尾病变。良性或交界性胰体尾病变保脾率50．0％（22／44）。结论根据胰腺肿瘤性质、大小和部位，以及脾动、静脉与胰腺或胰腺肿瘤的关系，主动选择术式和规划手术路径，有助于提高腹腔镜胰体尾切除术的安全性和保脾率。Objective To discuss the strategy and technique of laparoscopic distal pancreatectomy（LDP） in the treatment of tumors in the body or tail of the pancreas. Methods The clinical data of 56 cases of tumors in the body or tail of the pancreas performed LDP from April 2012 to June 2014 in Zhejiang Provincial People＇s Hospital and Zhangzhou Municipal Hospital of Fujian Province were analyzed retrospectively. Results Among the 56 cases, laparoscopic procedure was successfully performed in 53 cases, only 3 cases （5.4%） were converted to laparotomy. LDP with splenectomy, spleen-preserving LDP with conservation of the spleen vessels（Kimura procedure）, spleen-preserving LDP without conservation of the spleen vessels（Warshaw procedure）were performed in 31 （58.5%）,19 （35.8%） and 3 cases （5.7%）, respectively. The operation time was 70 to 230 rains with a time of （170＋35）mins; the intraoperative blood loss was 50 to 310 mL with the mean volume of（110＋34） mL; the postoperative hospital stay was 5 to 35 days with the mean value of （9＋6）days. Postoperative complications included 13 cases of grade A pancreatic fistula （23.2%）, 1 case （1.8%） of grade B pancreatic fistula and 1 case（1.8% ）of intra-abdominal abscess, 2 cases of pneumonia（3.6%） . Radiology and pathology were analyzed postoperatively： 12 cases of pancreatic duct carcinoma, 23 of boarderline tumors （〉Scm）, 2 of chronic pancreatitis were found in converting laparotomy, LDP with splenectomy and Warshaw procedure. All the Kimura procedures were performed in benign or boarderline tumors with diameters less than 〈 5cm, with the spleen-preserving rate of 50% （22/44）. Conclusion Well selected surgical procedures and path according to the tumorcharacteristics, size, location and the anatomic relationship with spleen vessels could effectively improve the safety and the spleen preservation rate in LDP.

关 键 词：胰腺肿瘤 胰腺切除术 腹腔镜 保留脾脏胰体尾切除术 

分 类 号：R6[医药卫生—外科学]